参附注射液对心脏骤停心肺复苏术后患者脏器功能保护作用研究

Protective Effect of Shenfu Injection on Organ Function in Patients with Cardiac Arrest after Cardiopulmonary Resuscitation

目的观察参附注射液对心脏骤停心肺复苏术后患者脏器功能的保护作用。方法选取我院2017年3月-2018年6月收治的心脏骤停后心肺复苏成功患者83例,根据心脏骤停心肺复苏术后治疗方法的不同分为观察组43例和对照组40例。对照组给予常规救治,观察组在常规救治基础上联合参附注射液治疗。比较两组心肺复苏成功即刻及治疗后24、48 h时血C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、神经元特异性烯醇化酶、氧合指数、心肌型肌酸激酶同工酶(CK-MB)、肌钙蛋白T(cTnT)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、血肌酐(Cr)、尿素(BUN)水平,以及1个月生存率。结果两组复苏成功后24、48 h CRP和TNF-α水平均较复苏成功即刻升高,且复苏成功后48 h上述指标升高更为明显(P<0.05或P<0.01);观察组复苏成功后24、48 h CRP和TNF-α水平均低于对照组同时间(P<0.05)。两组复苏成功后24、48 h神经元特异性烯醇化酶较复苏成功即刻降低,氧合指数较复苏成功即刻升高,且复苏成功后48 h神经元特异性烯醇化酶降低及氧合指数升高程度更为显著(P<0.05或P<0.01);观察组复苏成功后24、48 h神经元特异性烯醇化酶均低于对照组同时间,氧合指数均高于对照组同时间,差异均有统计学意义(P<0.05)。两组复苏成功后24、48 h CK-MB、cTnT、AST、ALT、Cr、BUN水平均降低,且复苏成功后48 h CK-MB、cTnT、AST、ALT、Cr、BUN降低程度更为显著(P<0.05或P<0.01);观察组复苏成功后24、48 h CK-MB、cTnT、AST、ALT、Cr、BUN水平均低于对照组同时间(P<0.05)。观察组1个月生存率为76.74%高于对照组1个月生存率52.50%,差异有统计学意义(P<0.05)。结论心脏骤停心肺复苏术后患者给予参附注射液治疗,可有效减轻相关脏器损伤程度,保护脑、肺、心肌、肝肾功能,并能改善患者预后。

Objective To observe the protective effect of Shenfu injection on organ function in patients with cardiac arrest after cardiopulmonary resuscitation(CPR).Methods Eighty-three cases of cardiac arrest undergoing CPR successfully were selected from March 2017 to December 2018 in our hospital.According to the different treatment methods after CPR,they were divided into observation group(n=43)and control group(n=40).The control group was given conventional treatment,while the observation group was treated with Shenfu Injection on the basis of conventional treatment.The levels of serum C-reactive protein(CRP),tumor necrosis factorα(THF-α),neuron specific enolase,oxygenation index,cardiac creatine kinase isoenzyme(CK-MB),troponin T(cTnT),aspartate aminotransferase(AST),alanine aminotransferase(ALT),serum creatinine(Cr),and blood urea nitrogen(BUN)immediately after CPR,and at 24 h and 48 h after treatment were compared.In addition,1-month survival rate were measured.Results The levels of CRP and TNF-αin the two groups at 24 and 48 h after successful CPR were significantly higher than those immediately after CPR,and the levels was much higher at 48 h after successful CPR(P<0.05 or P<0.01).The levels of CRP and TNF-αat 24 and 48 h after successful CPR were significantly lower in observation group than in control group at the same time point(P<0.05).As compared with those immediately after successful CPR,the neuron specific enolase was decreased and oxygenation index was increased at 24 and 48 h after successful CPR,which was more pronounced at 48 h after resuscitation(P<0.05 or P<0.01).The neuron specific enolase at 24 and 48 h after resuscitation in the observation group was lower,while the oxygenation index was higher,as compared with those in the control group at the same time point(P<0.05).The levels of CK-MB,cTnT,AST,ALT,Cr,BUN in the two groups were all decreased at 24 and 48 h after successful resuscitation,and the levels of the above indicators were more significantly decreased at 48 h after successful resuscitation(P<0.05 or P<0.01).The levels of CK-MB,cTnT,AST,ALT,Cr,BUN at 24 and 48 h after successful resuscitation in the observation group were all lower than those in the control group at the same time point(P<0.05).The 1-month survival rate of the observation group was 76.74%,which was higher than that of the control group(52.50%)(P<0.05).Conclusion For patients with cardiac arrest undergoing CPR,Shenfu Injection can effectively reduce the damage of related organs and tissues,protect brain,lung,myocardium,liver and kidney function,and improve the prognosis.